Cephalad-caudad blunt expansion technique safer in Cesarean delivery, finds research

Cesarean delivery is a commonly performed abdominal surgery worldwide and is essential for ensuring the safe delivery of a healthy baby and maintaining the mother's health. Recent research aimed to assess the efficacy of blunt uterine incision expansion in the cephalad-caudad (CC) direction versus the transverse direction in minimizing intraoperative injuries and blood loss in women undergoing lower segment transverse cesarean delivery. This study was a randomized controlled trial that compared the outcomes of two different techniques for blunt uterine extension during cesarean deliveries. The study involved 154 pregnant women at or beyond term undergoing cesarean section and randomly assigned them to either a cephalad-caudad (CC) expansion group or a transverse (TS) expansion group.

Primary Outcomes and Secondary Outcomes

The primary outcomes evaluated were the estimation of unintended intraoperative injuries, such as uterine artery injury and uterine tissue extension, as well as the drop in hemoglobin level after the procedure. The secondary outcomes assessed were postoperative complications. The results showed that the number of unintended uterine artery injuries was similar between the CC and TS expansion groups (7.8% vs 9.1%, p=0.7). There was also no significant difference in the number of unintended uterine tissue extensions (1.3% vs 2.6%, p=1.0). The mean difference in hemoglobin drop was not statistically significant between the two groups (0.9 ± 1.1 vs 1.0 ± 1.1, p=0.3).

Secondary Outcomes Comparison

Regarding secondary outcomes, postpartum hemorrhage (PPH) occurred in 4 (5.2%) patients in the TS group, with one needing blood transfusion, while no PPH was observed in the CC group (p=0.1). The mean difference in visual analog scale (VAS) scores for postoperative pain was also not significant between the groups (2.8 ± 1.6 vs 2.5 ± 1.6, p=0.2). There were no cases of endometritis, fever, or sepsis reported.

Conclusion

The study concluded that the cephalad-caudad blunt expansion technique is equally safe compared to the transverse expansion technique during cesarean deliveries. The authors suggest that the cephalad-caudad expansion technique should be considered in practice, as it may provide potential benefits and can be safely performed by surgeons of varying experience levels.

Key Points

Here are 6 key points from the research paper:

1. The study was a randomized controlled trial that compared the outcomes of two different techniques for blunt uterine extension during cesarean deliveries - cephalad-caudad (CC) expansion and transverse (TS) expansion.

2. The primary outcomes evaluated were the estimation of unintended intraoperative injuries, such as uterine artery injury and uterine tissue extension, as well as the drop in hemoglobin level after the procedure.

3. The results showed no significant differences between the CC and TS expansion groups in the number of unintended uterine artery injuries, unintended uterine tissue extensions, or the mean difference in hemoglobin drop.

4. Regarding secondary outcomes, postpartum hemorrhage (PPH) occurred in 5.2% of patients in the TS group, with one needing blood transfusion, while no PPH was observed in the CC group. The mean difference in visual analog scale (VAS) scores for postoperative pain was also not significant between the groups.

5. There were no cases of endometritis, fever, or sepsis reported in either group.

6. The study concluded that the cephalad-caudad blunt expansion technique is equally safe compared to the transverse expansion technique during cesarean deliveries, and that the cephalad-caudad expansion technique should be considered in practice as it may provide potential benefits and can be safely performed by surgeons of varying experience levels.

Reference –

Miuli I, John LB, Desikan S, Govindasamy E. Comparison of the Outcomes of the Conventional Blunt Uterine Expansion Technique to Cephalad-caudad Expansion in Cesarean Section: A Randomized Controlled Trial. J South Asian Feder Obs Gynae 2024; 16 (4):341-345.